A past teacher, caregiver, or romantic partner might have negatively affected an individual - all contributing to someone’s adult depression. Or specific childhood experiences, poverty, traumas, or poor parenting, or any combination of these experiences, are definitely considered possible depression triggers.
The type of therapy known as interpersonal psychotherapy (IPT) recognizes all of these past relationships and situations as predisposing factors, but it doesn’t dwell on them, or try to therapeutically resolve them.
Instead, IPT focuses on helping individuals change behaviors today that are directly linked to depression, placing the most emphasis on an individual’s current social and interpersonal relationships. This therapeutic school believes that these relationships directly affect mood.
For example, depressed individuals feel miserable, trying to piece together “where things have gone wrong,” often dwelling on all their perceived failures or injustices. IPT acknowledges the influence of past factors, but also stresses that once individuals become depressed, the reverse also occurs: individuals lose their ability to communicate and interact well with others, causing more depression and adversity.
In other words, depression occurs within the context of social environments – not in isolation.
The “Oxford Textbook of Psychotherapy,” edited by Glen O. Gabbard, Judith S. Beck, and Jeremy Holmes,” lists the following characteristics of IPT:
- Short-term therapy. IPT is not a several month treatment, but takes place for approximately 12 to 20 weeks. Time-limited therapy encourages the patient to immediately take corrective actions in their lives. It also reduces the probability that the patient will form a dependence on the therapist. This type of therapy does not encourage an unlimited discussion of “problems” but instead focuses on the interpersonal behaviors that need to change in order to bring meaningful relationships and positive interactions back into the patient’s life.
- Focused therapy. During the first few therapy sessions, the therapist and patient pinpoint one or two key problem areas or relationships currently affecting the patient’s depression. The therapy does not try to solve all of an individual’s problems, preventing the therapy from becoming open-ended. However the therapist remains flexible throughout the course of therapy, changing directions if corrections or adjustments need to occur.
- Emphasize current not past relationships. IPT focuses on current social relationships, emphasizing the need to improve current situations. It recognizes how past significant relationships and episodes of depression have affected and formed the individual, but does not address the past.
- Concerned with interpersonal not intrapsychic. Some schools of therapeutic thought, such as psychodynamic and humanistic therapies, explore an individual’s inner conflicts and perceptions – but not IPT. Instead, IPT acknowledges inner conflicts but moves past them, avoiding any in-depth interpretations. This therapy does not try to connect interpersonal problems to specific elements of personality or unconscious motivations.
- Concerned with interpersonal, not cognitive behavioral therapy (CBT). Similar to CBT, IPT draws attention to distorted thought patterns. However, IPT does not work with the patient to systematically analyze these thoughts, or aid in developing alternative thoughts. Rather, the therapy emphasizes unhealthy, distress interactions with others that directly cause mood changes in the patient. For more information, see cognitive behavioral therapy.
Areas of Depression Related to Social Dysfunction
- Extreme grief and bereavement after the loss of a close friend or loved one;
- Conflict in major or significant relationships;
- Struggling to adapt to changing social relationships or major changes in life circumstances;
- Difficulties related to social isolation.
The goal of an IPT therapist is to guide the patient in identifying the main issue contributing to depression, such as conflict within a marriage, or with a manager, or with a new mother or father after a parent’s divorce and remarriage.
Then the therapist addresses the behaviors that need to change in order to develop a healthier relationship, and helps build the skills to change these behaviors, skills that contribute to reducing depression. The therapist also helps the patient observe mood changes related to events and interactions that occur within relationships, and through role-playing and problem solving, to come up with healthier communication patterns and ways to resolve specific conflicts.
IPT therapists typically customize a therapeutic plan for each individual and his or her type of depression, severity, and the specific problems that the individual struggles with on a regular basis. In almost all cases, however, each therapeutic plan contains a “communication analysis.”
During this analysis, the therapist asks the patient for a detailed account of troublesome interactions with a significant other, recalling specific statements, tone of voice used, body language, and gestures that each person exhibited during the exchange.
Passive behavior is typically associated with depression, for example. A patient with passive behaviors and depression could be struggling in a romantic relationship with a significant other who seems to always take charge, or make all the decisions. Similarly, another patient with an elderly, ill parent and an overly aggressive sister struggles with depression because of always having to take orders from that sister.
The therapist working with patients displaying passive behaviors will have patients detail conversations that left them feeling taken advantage of, unable or unwilling to express their wishes.
A Communication Analysis Case Study
In the case of the aggressive sister, the therapist analyzes the following encounter as retold by a female patient:
The aggressive sister shouted or loudly demanded that the patient take the parent to the doctor, giving orders of what to tell the doctor, all the while standing in a hovering position, and pointing her finger at the patient.
All the while the patient looked away from her sister, hunched, and simply said okay. Anger and resentment at the sister led to increased depression, and a self-defeating resignation that the patient had no choice or say in this situation. Additionally, the patient felt guilty for not wanting to take the parent to the doctor because of the parent’s poor health.
The therapist has the patient consider a number of alternative ways to handle this situation. The therapist might have the patient say or write out alternative responses, and role-play the alternatives. The therapist takes the place of the aggressive sister, coming up with detriments to the positive, assertive behavior the patient practices in order to help the patient think proactively.
In teaching assertiveness, the therapist goes over the following important features of healthy, productive responses:
- Backing away from the aggressive sibling allowing an appropriate amount of personal space.
- Positioning oneself with good posture.
- Making eye contact.
- Keeping control of facial gestures or expression that might show angst, displeasure, or distress.
- Using a firm but pleasant voice.
- Asking clarifying questions.
- Using “I” statements, such as “I cannot keep taking time off of work or I will lose my job. I don’t understand why we can’t split these responsibilities more evenly.”
- Remaining calm and refraining from becoming emotional.
Through the discussion with the patient, the therapist will also address the issue of guilt, making statements such as: “It’s normal to want to help an elderly parent who is sick, and to both feel bad for the parent, and to sometimes feel guilty when more help can’t be provided.”
This encourages the patient to discuss the situation more thoroughly, helping the patient realize that being able to help also means taking care oneself so that the patient is fully present and helpful to her parent during the times that she does assume caregiving responsibilities.
As with other evidence-based therapies, IPT draws on a body of research to develop its techniques and interventions that help patients better manage their depression. This type of therapy has shown significant positive results in a number of large and small case studies designed to measure its effectiveness. It is often combined with medication to achieve the best overall outcomes.
If you desire to help depressed individuals or others with mental health disorders using therapies such as IPT, consider a career as a mental health counselor. Contact mental health counseling schools for more information on this career, and the mandatory educational requirements needed to become a counselor.